Medicaid Pending Process

3 Requirements that must be met to be Medicaid PEND. ABE – (Application for Benefits Eligibility) required for all PEND Residents and must be completed by the facility prior to or no later than next day of admission. The ABE upload for documents should not be used to upload additional documents after the application has been submitted. All additional documents should be emailed or faxed. PEND Residents with Limited Medicaid Benefits indicated on the Medicare/Medicaid Screening require a new application. No application is required for a Resident having active Community Medicaid Benefits. The Community Medicaid Benefits and RIN (Resident Identification Number) can be verified on the Resident’s Medicare /Medicaid Screening which is required on all admissions. A HFS 3654 is required to be submitted. A HFS 3654 (Additional Financial Information for Long Term Care Applicants form) is required and can be submitted later to the DHS Office, but must be submitted As Soon As Possible.

3 Requirements that must be met to be Medicaid PEND. OBRA/HFS 2536 (Certificate of Screening Results) must be submitted with the 1156. Admitting HFS 1156 (Long Term Facility Notification Form) must be submitted to the 1156 mailbox. If requirements are not met, the facility must admit resident as Private Pay Medicaid Intended. Resident can only be on PPMI a Maximum of 10 days. If PEND requirements are not met by the 11th day as PPMI, the facility needs to review the resident status with their Regional Director for starting an Involuntary discharge if the Resident is unable to pay privately and collect the appropriate PRIV advance payment.

Medicaid is a 2 Step Process for Your Facility to Get Paid! (Step 1) Resident must be Approved for Medicaid benefits by the DHS Office (Step 2) Resident must be Admitted into your facility by the DHS office.

Understanding How to Complete the DHS PEND Spreadsheet Spreadsheet is currently only for facilities assigned to the Macon DHS Office. Spreadsheets will be sent to DHS one time a month by the Home Office When Home Office receives the DHS’s responses they will forward the facility’s spreadsheet to the facility to update the facility’s AOD Notes and to follow-up on any case issues needing a response back to DHS

Facility Inquiry Spreadsheet

DHS Request Group DHS Request Group 1 - Due by 1st Thursday each month El Paso Health Care Center Flanagan Rehabilitation & Health Care Center Piper City Rehab & Living Center Sheldon Health Care Center Watseka Rehabilitation & Health Care Center Countryview Care Center of Macomb Aledo Rehabilitation & Health Care Center Bloomington Rehabilitation & Health Care Center Fondulac Rehabilitation & Health Care Center Havana Health Care Center Kewanee Care Home LaHarpe-Davier Health Care Center Marigold Rehab and Health Care Prairie City Rehab & Health Care Center Roseville Rehabilitation & Care Center Sunset Rehabilitation & Health Care Center Toulon Rehabilitation & Health Care Center Timbercreek Rehab & Health Care

DHS Request Group DHS Request Group 2 - Due by 2nd Thursday each month Bement Health Care Center Decatur Rehabilitation & Health Care Center Arcola Health Care Center Casey Health Care Center Charleston Rehab & Health Care Center Cumberland Rehab & Health Care Center Eastview Terrace Farmer City Rehab & Health Care Illini Heritage Rehab & Health Care Mason Point Newman Rehabilitation & Health Care Center Palm Terrace of Mattoon Shelbyville Rehabilitation & Health Care Center Sullivan Rehabilitation & Health Care Center Tuscola Health Care Center Twin Lakes Rehab & Health Care

DHS Request Group DHS Request Group 3 - Due by 3rd Thursday each month Cornerstone Rehabilitation & Health Care Royal Oaks Care Center COURTYARD ESTATES OF CANTON (SLF) COURTYARD ESTATES OF PEORIA (SLF) COURTYARD ESTATES OF SULLIVAN (SLF) Legacy Estates of Monmouth (SLF) Benton Rehabilitation & Health Care Center Cisne Rehabilitation & Health Care Center Collinsville Rehabilitation & Health Care Center Countryview Terrace DD Facility Eastside Health & Rehabilitation Center Effingham Rehabilitation & Health Care Center Enfield Rehabilitation & Health Care Center Flora Gardens Care Center Flora Rehabilitation & Health Care Center

DHS Request Group Macon DHS Request Group 4 - Due by 4th Thursday each month Jonesboro Rehabilitation & Health Care Center Lebanon Care Center McLeansboro Rehabilitation & Health Care Center Mt. Vernon Health Care Center Nokomis Rehab & Health Care Center Prairie Rose Health Care Center Robings Manor Rehabilitation & Health Care Rosiclare Rehabilitation & Health Care Center Shawnee Rose Care Center Swansea Rehabilitation & Health Care Center Vandalia Rehabilitation & Health Care Center Westside Rehabilitation & Health Care Center Whispering Oaks Care Center DD Facility White Oak Rehabilitation & Health Care Center Willow Rose Rehab & Health Care

DHS Request Group Schedule pending- Chicago MFO DHS Request Group 5 Batavia Rehabilitation & Health Care Center North Aurora Care Center Pleasant View Polo Rochelle Gardens Care Center Rochelle Rehabilitation & Health Care Center Rock Falls Rehabilitation & Health Care Center Rock River Gardens Sandwich Rehabilitation & Health Care Center Sauk Valley Senior Living & Rehabilitation South Elgin Rehabilitation & Health Care Center